Last updated: 15 July 2026. Next review: 15 January 2027

There are currently only two NICE-approved treatments for alopecia areata – the JAK inhibitor medications ritlecitinib (brand name Litfulo) and deuruxolitinib (brand name Leqselvi).

NICE stands for the National Institute for Health and Care Excellence. NICE is an independent, non-governmental public body that provides national guidance and advice to improve health and social care. NICE assesses whether new medicines are clinically effective and represent good value for the money, and decides whether they should be available via the NHS. 

In Scotland, it is the Scottish Medicines Consortium (SMC) which evaluates clinical and cost-effectivenes of newly licensed medicines for NHS Scotland.

This page is designed to assist people with alopecia areata who may be wishing to explore a NICE-recommended JAK inhibitor medication as a treatment option. If you do not have severe alopecia areata, ritlecitinib or deuruxolitinib will not be a treatment under consideration for you. 

Confirm your eligibility under NICE and SMC guidelines

• You need to have severe alopecia areata*, which is defined as having at least 50% loss of scalp hair*
• You must be aged 12 years or over to be considered for ritlecitinib, or aged 18 years or over to be considered for deuruxolitinib.
• The doctor responsible for your care believes that a JAK inhibitor medication is the right treatment for you, and you meet the specific criteria related to your health status and risk factors. (Baseline screening e.g. blood tests, and sometimes genetic tests, will be required prior to the commencement of any JAK inhibitor treatment to ensure it is safe for you to take, and regular health checks will be required to ensure your safety. There are health-related exclusions that could mean a doctor is unable to prescribe a JAK inhibitor medicine, including tuberculosis, hepatitis B or C, thromboembolic events, pregnancy and breastfeeding – please note, this is not an exhaustive list).

*Regarding alopecia areata severity levels, the ritlecitinib guidance note created by the British Association of Dermatologists, Alopecia UK, and British Hair and Nail Society states that people with moderate alopecia areata (21%-49% scalp hair loss) may have their severity rating increased by one level to severe if other factors are present. These factors are:

• • Negative impact on psychological functioning resulting from alopecia areata
  • Noticeable involvement of eyebrows and eyelashes
  • Inadequate response after at least 6 months of treatment (treatments include topical, intralesional or oral steroids, etc)
  • Diffuse (multifocal) positive hair pull test consistent with rapidly progressive alopecia areata

There may be other factors which could increase the severity rating.

If you do have any of the other factors, your severity level will only be raised by one level. ‘Mild’ alopecia areata may be raised a level to ‘moderate’, but not to ‘severe’ which is the required severity rating to be prescribed a JAK inhibitor medication.

We do not expect anyone with mild alopecia areata (up to 20% scalp hair loss) to be prescribed a JAK inhibitor. 

If you meet the above eligibility criteria, your dermatologist should be able to prescribe a JAK inhibitor if they think this type of medicine is in your best interests. Please note, we expect JAK inhibitor treatments to be managed exclusively by dermatologists and we do not expect GPs will prescribe JAK inhibitor medicines. 

Understanding how the UK nations implement new medicines

The below table has been created to help you understand the different processes that exist in the four nations of the UK regarding the implementation of new medicines.

The process for accessing new medicines in each of the four nations

Nation	Process for Accessing NICE-Approved Medicines	Responsible Body
England	Must fund NICE-approved medicines within 90 days of final gudiance publication (or 30 days for medicines evaluated through the NICE Cost Comparison Process).	Department for Health and Social Care (DHSC)/Local ICBs
Wales	Follows NICE guidance and must also fund medicines within 90 days of final guidance publication (or 30 days for medicines evaluated through the NICE Cost Comparison Process).	NHS Wales
Scotland	Uses Scottish Medicines Consortium (SMC) guidance and typically fund medicines within 60 days of final guidance publication.	NHS Scotland / Local Health Boards
Northern Ireland	Generally, follows NICE guidance, but implementation is slower.	Health and Social Care Board (HSCB)

What to do if your NHS Trust, ICB or Health Board refuses you access to a JAK inhibitor medicine

If you are refused access to a JAK inhibitor medicine, and you believe you meet the eligibility criteria, firstly ensure that the medical professionals involved in your care have a thorough understanding of JAK inhibitors. Show them the guidance note and ensure they understand about NICE (or in Scotland, SMC) approval.

If you are still met with a 'no', request a written explanation from the NHS body that refused access and ask:

• On what grounds was the request denied?
• Are they aware that ritlecitinib is approved by NICE (under Technology Appraisal TA958) and SMC (under Detailed Advice Document SMC2610) for routine use for people with severe alopecia areata aged 12 and over?
• Are they aware that deuruxolitinib is approved by NICE (under Technology Appraisal TA1178) for adults aged 18 and over with severe alopecia areata? (No SMC decision at time of publishing this webpage)
• Do they understand that there is a statutory obligation to make treatments recommended by NICE Technology Appraisals routinely available? Ritlecitinib was recommended by NICE on 27^th March 2024, and as such should be available for prescribing. Deuruxolitinib was recommended by NICE on 15th July 2026, and as such should be available for prescribing from 14th August 2026. 

For Scotland - Please note, SMC accepted ritlecitinib for use within NHSScotland on 8^th April 2024 . After the SMC approves a medicine, NHS boards in Scotland are expected to make it available within a certain timeframe, typically within 60 days of the advice being published.  However, unlike NICE recommendations, SMC recommendations are not statutory or legally binding. NHS boards in Scotland are not obligated to follow SMC’s advice, though it is generally considered best practice to do so. At time of creating this page, SMC are yet to publish their decision on deuruxolitinib. We will update the page as soon as we know their decision.

We understand, from hearing the experiences of people in our community, that asking for written confirmation of the reasons for refusal can sometimes be enough to change the position. We know that access can be inconsistent across the UK.

If you continue to be refused access to a NICE/SMC recommended JAK inhibitor medicine, and you remain confident that you meet all the eligibility requirements and would like to try this treatment, consider raising a formal complaint.

How to raise a complaint about your NHS care?

We have pulled together this webpage to provide you with the information you need to raise a complaint about your NHS care. Our information page provides useful links to help you navigate the complaints process in England, Wales, Scotland and Northern Ireland.